Traumatic Lesions

Arlene and Natalie
—NON - PLAQUE-INDUCED GINGIVAL LESIONS—
Traumatic lesions (factitious, iatrogenic or accidental)
Chemical injury:

Clinically- Generalized whitish hyperkeratosis with erythmatous underneath, necrotic and sloughing of tissue, diffused irregular boarders, ulcerative and painful along the free and attached gingival.
Radiographically- noneOrganisms associated with this include mostly gram positive cocci and rods and maybe some gram negative bacteria because this lesion is non-plaque induced. These bacteria include S. sanguis, S. mitus, and A. viscous. The cells involved will be the ones associated with the infalmmatory response due to the increased blood flow and dilation of capillaries. These cells include the PMN's, macrophages, NK.Diagnose: Clincally and ask patient what they have been rinsing with or if they have been placing anything in that area and if it is painful.Differential diagnosis- hydrogen peroxide, phenol burn, aspirin burn.


Physical injury:

Clinically- Localized erythemia located on the free and attached gingiva on the buccal surfaces.
Radiographically- none
Organisms associated with this include mostly gram positive cocci and rods and maybe some gram negative bacteria because this lesion is non-plaque induced. These bacteria include S. sanguis, S. mitus, and A. viscous. The cells involved will be the ones associated with the infalmmatory response due to the increased blood flow and dilation of capillaries. These cells include the increase neutophils, PMN's, macrophages, NK.
Diagnose clinically and asking patient if they are placing anything in that area or scratching. Differential diagnosis: physical trauma by fingernail scratching, allergic reaction, chemical burn.
—Thermal injury

1. What it would look like clinically- Mucosal burns are commonly on the palate and tongue. Lesions appear erythematous and as they begin to heal, the center may appear more yellow-white in appearance with erythematous borders; much like an apthous ulcer.
2. What it would look like radiographically- None.
3. How you would diagnosis it (what would your differential diagnosis be?)- Health history questionnaire and through discussion. Ask how long it has been there and how did it happen. Most common burns are associated with hot food or beverage, hydrogen peroxide or eugenol.
4. Specific organism associated with the gingival disease- None.

—Foreign body reactions

1. What it would look like clinically- localized inflammation with red or red and white chronic lesions that may be painful and are reminiscent of desquamative gingivitis; foreign material in the gingival connective tissue through breaks in the epithelium. Common examples are amalgam and abrasives from polishing, and other foreign material that gets lodged in the sulcus, like small seeds or the shell of a popcorn kernel.
2. What it would look like radiographically- If it was amalgam left behind or an overhang, the amalgam will appear radiopaque. No bone loss would be noted.
3. How you would diagnosis it (what would your differential diagnosis be?)- Differential diagnosis would be desquamative gingivitis (pemphigus, lichen planus, erythema multiforme or drug eruption) or foreign body reaction. It would be diagnosed through exploring with an explorer and through radiographic interpretation. Also you could go through a systematic approach through discussion to find out what triggered the inflammation. Questions like how long has it been there? Has it got worse? You could also do a simple clinical maneuver such as Nikolsy’s sign. You could rule out a desquamative gingivitis by performing a biopsy. Once the diagnosis has been established, proper management can then be implemented.
4. Specific organism associated with the gingival disease- Gram positive facultative species, normal resident flora such as S. sanguis, S. mitis, and A. viscosus. There would also be inflammatory cells like PMSs, macrophages and cytokines would be working to try to phagocytize the foreign material.

—Not otherwise specified

1. What it would look like clinically- These findings would have an unknown etiology.
2. What it would look like radiographically- Vary.
3. How you would diagnosis it (what would your differential diagnosis be?)- Biopsy, however these types of findings will come back with a report of etiology not know.
4. Specific organism associated with the gingival disease- Vary.